I recently attended the Westminster Health Forum policy conference Environmental sustainability in healthcare - drivers for change, incentives and measurement, and priorities for the NHS, 2nd July 2020.  The NHS has had to undergo a dramatic transformation in order to continue delivering healthcare to the population during COVID-19.  A scale of change, like never before, has been achieved in a very short time, with the potential for a more environmentally sustainable health service going forward.

According to the World Health Organization's recent report, 23% of all global deaths are causally linked to environmental factors, approximately 12.6 million deaths per year. The NHS is a world leader in the response to the climate crisis, because of a decade of work that has been invested in this.  They are currently working towards net zero carbon, which they are looking to achieve by transforming their own activities and across the supply chain. 

One area of healthcare which could make a significant environmental impact is outpatient services.  During COVID-19, outpatient services across the country were delivered remotely.  This significantly reduced the amount of carbon produced by patients traveling to appointments.  According to research published by Public Health England, long-term exposure to man-made air pollution contributes to between 28,000 to 36,000 deaths per year.

Sonia Roschnik, International Climate Policy Director, Health Care Without Harm, identified a number of climate-smart healthcare initiatives:

• Lifestyle disease prevention
• Care closer to home
• Low VOC materials
• Local Food Suppliers
• Waste Recycling
• Air Quality

"Telecare is one of the biggest actions we can do. A scale of change has been achieved and can be achieved in the future."

Sonia Roschnik, International Climate Policy Director, Health Care Without Harm

There is great potential for the NHS to look at establishing local supply chains and solutions.  If the pandemic has taught us anything it is that efficiency isn't always achieved through cost.  Availability and reliability are equally important considerations, along with reusability where appropriate.

Dr Nick Watts, Chair, NHS Net Zero Expert Panel and Executive Director, Lancet Countdown, highlighted some of the health benefits of climate action: mental health and social equality, clean air, physical activity and healthy diets.  The interventions required to achieve these benefits include having access to clean household energy, low-carbon electricity, efficient  transport system, sustainable healthcare, and reduced red and processed meat.

Dr Olivia Bush, Clinical Programme Director, The Centre for Sustainable Healthcare shared an example from Coventry of how telecare has benefited a group of kidney transplant patients. Rather than having to attend frequent outpatient appointments at hospital, if the patients were stable, they had a telephone follow-up four times a year.  This reduced travel, social impact (individual's time and employment commitments), and reduces clinicians' time.  All of this was achieved using existing technologies.  This is how she described their sustainable quality improvements programme:

"To deliver care in a way that maximises positive health outcomes and avoid both financial waste and harmful environmental impacts, while adding social value at every opportunity."

Dr Olivia Bush, Clinical Programme Director, The Centre for Sustainable Healthcare

Case Study: Shine, Sustainable Healthcare in Newcastle

Newcastle Upon Tyne Hospitals NHS Foundation Trust are a leading light on climate action in the UK.  They have seven main sites and community services serving a population of up to 3 million (one of the largest in the UK).  They have 1500 acute beds, 108 wards, and a 15,000 strong workforce. They were the first Trust to declare a climate emergency in the world, and 15 years ago became the first site in Europe to use reusable sharps containers.  They have a completely electric transport fleet.

So, why declare a climate emergency? Dr Vicky McFarlane-Reid, Director of Business and Enterprise, The Newcastle upon Tyne Hospitals NHS Foundation Trust, said it is because they recognise that it's the biggest threat to health.  As healthcare providers, they understand that their first commitment is to do no harm, so they believe that they have a moral obligation to reduce the effects of carbon emissions. The Newcastle upon Tyne Hospitals NHS Foundation Trust have three target areas for 2020: energy, journeys (travel) and plastics.

Since their outpatient services moved to telecare as a result of COVID-19, they undertook some analysis on the environmental impact of this change to service.  They linked outpatient appointments to postcodes and calculated 600,000 reduced patient miles in the month of May alone. In Newcastle City, NHS hospitals account for 19.3% of total gas consumption, which is used for heating and electricity.  Building use and travel are the second and third largest sources of carbon emissions.  The Newcastle upon Tyne Hospitals NHS Foundation Trust are exploring the use of hydrogen to replace CHP and electric heat pumps, and the use of solar panels where possible. 

"Saving carbon saves money."

Dr Vicky McFarlane-Reid, Director of Business and Enterprise, The Newcastle upon Tyne Hospitals NHS Foundation Trust

The Newcastle upon Tyne Hospitals NHS Foundation Trust have also developed Shine (Sustainable Healthcare in Newcastle) to deliver their sustainable healthcare vision. Dr Vicky McFarlane-Reid commented that developing sustainability across the NHS Trusts comes from leadership, and that they have developed their own brand (Shine), which is very accessible and easy for staff to engage with. 

They have also implemented Green Champions across their service.  The role of a Green Champion gives an opportunity for genuine enthusiasts, people who have really taken sustainable healthcare to heart, to have a positive impact.  The champions act as a point of contact in clinical, non-clinical and administrative areas.  Any member of staff with an idea can feed it to their Green Champion, who will feed it up to management with a view to cascading it across the organisation.  In this way they are looking to find innovative ideas to help identify what can be done differently.

Shine helps people in the Trust to understand the importance of the message, but enables people to be active in making the change, with a top down and bottom up approach an effective form of crowd sourcing.

Post Contributor:

Caitriona Fitzsimons Digital Reporter